Somatic mutations in the gene encoding transcription factor GATA-1 are associated with acute megakaryoblastic leukemia (AMKL) in children with Down syndrome (DS, trisomy 21), although the mechanisms underlying this genetic interaction are unknown. In preliminary studies, I demonstrated that trisomy 21 itself increases the proliferative capacity of human erythroid and megakaryocyte progenitors. In parallel murine studies, I used genetically manipulated embryonic stem cells to show that loss of GATA-1 promotes the expansion of bipotential megakaryocyte-erythroid precursors (MEPs), a population that resembles AMKL blasts. Through genetic complementation of the mutant MEPs, I discovered that GATA-1 represses a program of myeloid differentiation, in part by inhibiting transcription of the protooncogene PU.1/Sfpi1. This effect is attenuated by AMKL-associated GATA1 mutations. Together, my findings generate two related hypotheses: First, GATA1 mutations and trisomy 21 produce distinct effects on hematopoiesis, which act together to promote leukemia. Second, GATA-1 promotes normal hematopoiesis by repressing PU.1/Sfpi1 transcription and this process may become dysregulated through genetic alterations associated with DS-AMKL. This application is to support a mentored research experience to elucidate how GATA-1 controls normal hematopoiesis and how dysregulated GATA-1 and DS synergize in leukemogenesis. I will extend my studies in DS fetal hematopoiesis to understand the mechanisms by which trisomy 21 expand erythroid and megakaryocytic progenitors (Aim 1). I will examine functional interactions between altered GATA-1 and trisomy 21 in human hematopoietic progenitors in vitro and in mice (Aim 2). Lastly, I will study the mechanisms by which wild type and AMKL-associated mutant forms of GATA-1 repress PU. 1/SfpH oncogene transcription (Aim 3). If successful, my research will provide insights into the transcriptional control of normal erythromegakaryocytic development and how this process becomes disturbed in AMKL. The broader impact of this research is to better understand how a lineage-specific transcription factor functions in normal tissue development and cancer. Combined with my training and structured mentoring in this application, I believe that the proposed research will provide novel new insights into normal and malignant hematopoiesis and provide a strong foundation to establish my career as a pediatric physician-scientist.